PRIMARY HYPERPARATHYROIDISM

The parathyroid glands are small glands usually situated behind the thyroid gland at the base of the neck which produce parathyroid hormone (PTH) which controls the level of calcium in the blood. There are normally four parathyroid glands; although they are situated close to the thyroid gland their function is completely unrelated to that of the thyroid. The control of blood calcium levels is important for the proper functioning of the brain and nervous tissue and the maintenance of healthy bones. Too much PTH leads to too high a level of calcium in the blood and this can have various damaging effects. Mr McLaren will discuss with you why it is necessary to remove one or more of your parathyroid glands to control overproduction of PTH.

The Operation

Minimally Invasive Parathyroid Surgery (MIP)

Over 80% of patients with primary hyperparathyroidism are suitable for the minimally invasive parathyroid operation.

The MIP operation can be performed under local anaesthetic but is more comfortable with a short general anaesthetic.

The MIP operation involves only a 2cm incision in the neck.

The MIP operation will cure 95% of patients.

Conventional Open Parathyroidectomy

This is the traditional approach and is an excellent procedure involving a slightly longer incision (6-8cm). It is necessary in patients whose abnormal parathyroid gland cannot be accurately identified prior to surgery.

During the operation Mr McLaren will attempt to find and remove the abnormal parathyroid gland or glands and identify, inspect and possibly take samples from the other parathyroid glands. Abnormal glands may not be found at the time of operation in about one patient in twenty. One reason is that the gland may be so small or hidden that it cannot be found or seen. This happens very rarely. Another reason may be that the gland lies not in the neck but in the chest. If that is the case you may need another operation at another time to remove it.

Complications

Operations on the parathyroid glands are very safe but sometimes there are complications and this section summarises these for you.

The scar: Parathyroid surgery is undertaken through a scar that follows the natural creases in the neck. Usually it heals well leaving only a thin line but in some people the healing leaves a scar which is more coloured and thicker than the normal scar.

The voice: There are small nerves to the voice box (recurrent laryngeal nerves) which pass close to the parathyroid glands and may be damaged however carefully the operation is done. The effect of damage to one of these nerves is a weak or husky voice. These changes normally improve with time and the chance of you having a permanently abnormal voice is less than 1%.

Other complications: These are ones that are met after any operation – particularly bleeding within the wound and infection. These are not common but are mentioned for the sake of completeness.

Results of Surgery

From the situation of having too high a level of calcium before the operation, the calcium often falls to quite a low level shortly after the operation. This is because the other glands have become lazy or underactive. The other glands will recover their normal function quite quickly but you may require calcium and vitamin D tablets temporarily after the operation to boost the level of calcium in the body.

Operations to correct hyperparathyroidism are intended to improve symptoms which you are having which may be attributable to the hyperparathyroidism. You should discuss with your surgeon or physician the reasons why you have been referred for surgery and their expectations of improvement. Parathyroidectomy may be effective at controlling the hyperparathyroidism and reducing future damage but may not necessarily improve your current symptoms.

Appointments:

NHS Referrals
Mr A McLaren FRCS
Consultant Surgeon
Stoke MandevilleHospital
Aylesbury
Tel 01296 315072
Fax 01296 315199 / Private Referrals
Mr A McLaren
The ChilternHospital
Great Missenden
Buckinghamshire
HP16 0EN
Tel 01494 890890
Fax 01494 890250
WycombeHospital,
High Wycombe,
HP11 2TR / The PaddocksHospital
Aylesbury Road
Princes Risborough
Bucks, HP27 0JS
Tel – 01844 346951
Fax – 01844 344521